Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design

Carly Pymont*, Paul McNamee, Peter Butterworth

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
10 Downloads (Pure)


This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents’ prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15–$35; or >$35) were less likely to become FAs than those who incurred no or low (<AUS$15 per consultation) costs, with no difference evident between the no and low-cost groups. However, a counterfactual model that adjusted for factors associated with the selection into payment levels did not find an influence of payment, with only a non-significant gradient in the expected direction. Hence these findings raise doubts that price drives FA behaviour, suggesting that co-payments are unlikely to affect the number of GP consultations amongst frequent attenders.

Original languageEnglish
Pages (from-to)652-659
Number of pages9
JournalHealth Policy
Issue number6
Early online date20 Mar 2018
Publication statusPublished - Jun 2018

Bibliographical note

Acknowledgements: Thank you to the study participants, PATH Interviewers, Karen Maxwell and Trish Jacomb; and to the other PATH Chief Investigators: Kaarin Anstey, Helen Christensen, Anthony Jorm, Bryan Rodgers, Andrew Mackinnon, Simon Easteal and Nicolas Cherbuin. The PATH Through Life Study is funded by National Health and Medical Research Council Grants 973302, 179805 and 418039. Peter Butterworth is funded by ARC Future Fellowship FT13101444.


  • Frequent attendance
  • Out-of-pocket expenses
  • Primary health care


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